Healthcare Provider Details

I. General information

NPI: 1639073463
Provider Name (Legal Business Name): TREVOR DI CARLO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 FOREST AVE STE 1
RYE NY
10580-3696
US

IV. Provider business mailing address

332 STANLEY AVE
MAMARONECK NY
10543-2532
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-0856
  • Fax:
Mailing address:
  • Phone: 914-967-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: